U Assessment

HISTORY. Establish a sexual history, including the number of sexual partners and whether the patient was protected by a condom. Determine if any of the patient's partners were infected with a sexually transmitted infection (STI). Question the patient about intravenous (IV) drug use and previous STIs. With an infant, establish the sexual history of the mother.

Elicit a history of chancres. Ask the patient to describe the appearance, location, and duration of any chancres, particularly if they are no longer present. Establish a history of fever, headaches, nausea, anorexia, weight loss, sore throat, mild fever, hair loss, or rashes, symptoms of the primary and secondary stages. Determine if the patient has experienced paresis, seizures, arm and leg weakness, alterations in judgment, or personality changes, all of which are symptoms of late-stage syphilis.

PHYSICAL EXAMINATION. Carefully inspect the patient's genitalia, anus, mouth, breasts, eyelids, tonsils, or hands for a primary lesion. With female patients, be sure to determine if chancres have developed on internal structures such as the cervix or the vaginal wall. Chancres vary in appearance and location, depending on which stage the disease has entered, so record a detailed description of any lesions (Table 4).